Multilayer network instability underlying persistent auditory verbal hallucinations in schizophrenia.

Background: Auditory verbal hallucinations (AVHs) in schizophrenia (SCZ) are linked to brain network abnormalities. Resting-state fMRI studies often assume stable networks during scans, yet dynamic changes related to AVHs are not well understood.

Methods: We analyzed resting-state fMRI data from 60 SCZ patients with persistent AVHs (p-AVHs), 39 SCZ patients without AVHs (n-AVHs), and 59 healthy controls (HCs), matched for demographics. Using graph theory, we constructed a time-varying modular structure of brain networks, focusing on multilayer modularity. Network switching rates at global, subnetwork, and nodal levels were compared across groups and related to AVH severity.

Results: SCZ groups had higher switching rates in the subcortical network compared to HCs. Increased switching was found in two thalamic nodes for both patient groups. The p-AVH group showed lower switching rates in the default mode network (DMN) and two superior frontal gyrus nodes compared to HC and n-AVH groups. DMN switching rates negatively correlated with AVH severity in the p-AVH group.

Conclusions: Dynamic changes in brain networks, especially lower DMN and frontal region switching rates, may contribute to the development and persistence of AVHs in SCZ.